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Use of rate control medication before cardioversion of recent-onset atrial fibrillation or flutter in the emergency department is associated with reduced success rates
- Source :
- CJEM. 14(3)
- Publication Year :
- 2012
-
Abstract
- Objective:It is believed that when patients present to the emergency department (ED) with recent-onset atrial fibrillation or flutter (RAFF), controlling the ventricular rate before cardioversion improves the success rate. We evaluated the influence of rate control medication and other variables on the success of cardioversion.Methods:This secondary analysis of a medical records review comprised 1,068 patients with RAFF who presented to eight Canadian EDs over 12 months. Univariate analysis was performed to find associations between predictors of conversion to sinus rhythm including use of rate control, rhythm control, and other variables. Predictive variables were incorporated into the multivariate model to calculate adjusted odds ratios (ORs) associated with successful cardioversion.Results:A total of 634 patients underwent attempted cardioversion: 428 electrical, 354 chemical, and 148 both. Adjusted ORs for factors associated with successful electrical cardioversion were use of rate control medication, 0.39 (95% confidence interval [CI] 0.21-0.74); rhythm control medication, 0.28 (95% CI 0.15-0.53); and CHADS2score > 0, 0.43 (95% CI 0.15-0.83). ORs for factors associated with successful chemical cardioversion were use of rate control medication, 1.29 (95% CI 0.82-2.03); female sex, 2.37 (95% CI 1.50-3.72); and use of procainamide, 2.32 (95% CI 1.43-3.74).Conclusion:We demonstrated reduced successful electrical cardioversion of RAFF when patients were pretreated with either rate or rhythm control medication. Although rate control medication was not associated with increased success of chemical cardioversion, use of procainamide was. Slowing the ventricular rate prior to cardioversion should be avoided.
- Subjects :
- Adult
Male
medicine.medical_specialty
Canada
Adolescent
medicine.medical_treatment
Premedication
Electric Countershock
Amiodarone
Procainamide
Cardioversion
Propafenone
Internal medicine
Atrial Fibrillation
medicine
Humans
Sinus rhythm
Aged
Retrospective Studies
Aged, 80 and over
Univariate analysis
business.industry
Retrospective cohort study
Atrial fibrillation
Odds ratio
Emergency department
Middle Aged
medicine.disease
Confidence interval
Logistic Models
Treatment Outcome
Atrial Flutter
Multivariate Analysis
Emergency Medicine
Cardiology
Female
business
Anti-Arrhythmia Agents
Subjects
Details
- ISSN :
- 14818043 and 14818035
- Volume :
- 14
- Issue :
- 3
- Database :
- OpenAIRE
- Journal :
- CJEM
- Accession number :
- edsair.doi.dedup.....3621b47adb49916da836cd83732775bc